Over-the-counter painkiller may do more harm than good, researchers have
warned

Paracetamol does not stop lower back pain or help the ache of arthritis and doctors should consider prescribing exercise instead, a major review has found.

The over-the-counter painkiller, which is taken by millions of people in Britain for back problems, was found to be no better than placebo.

Around 26 million people suffer from back pain in Britain while nearly nine million have sought medical help for osteoarthritis, the most common form of arthritis.

But although clinical guidelines recommend paracetamol as the first line drug treatment for both conditions it has little effect and could cause long term liver damage, the University of Sydney warned in the British Medical Journal.

Lead author Gustavo Machado said the new research showed that guidance must be changed.

“Paracetamol is the most widely used over-the counter medicine for musculoskeletal conditions so it is critical that we review treatment recommendations in light of this new evidence,” he said.

“In our research, paracetamol for low back pain and osteoarthritis was also shown to be associated with higher risk of liver toxicity in patients.

“Patients were nearly four times more likely to have abnormal results on liver function tests compared to those taking placebo pills.”

In 2013 the National Institute for Health and Care Excellence (Nice) warned that continued use of paracetamol could lead to heart, kidney and intestinal problems, and recommended GPs only prescribe the lowest effective dose for the shortest possible time.

However the drugs regulator was forced into a u-turn last year following criticism from the Royal College of GPs and arthritis charities who said it would have a drastic impact on GP pain management.

The NHS spends around £80 million a year prescribing paracetamol yet other treatments such as spinal manipulation, exercise, acupuncture and psychological therapies are known to be effective.

Professor Christian Mallen, of the Arthritis Research UK Primary Care Centre, at Keele University, Staffordshire, said: “Non-pharmacological treatments work, are safe and have benefits that reach beyond the musculoskeletal system.”

“These findings encourage us to reassess the role of paracetamol as the key analgesic in management osteoarthritis and spinal pain.

“Changing behaviour of doctors and their patients is notoriously difficult but the findings emphasis that the time has come to shift our attention away from tablets as the default option for managing chronic musculoskeletal pain.

The new study included 13 randomised controlled studies that looked at the effects of paracetamol use compared with a placebo in around 40,000 patients.

The study showed that for lower back pain, paracetamol had no effect and did not reduce disability or improve quality of life compared with the use of a placebo. For osteoarthritis, they found small, but not clinically important benefits in the reduction of pain and disability.

Paracetamol use for osteoarthritis was also shown to increase the likelihood of having abnormal results on liver function tests by almost four times compared with a placebo.

Senior author Associate Professor Manuela Ferreira of the George Institute for Global Health and the University of Sydney added: “This latest research, the most comprehensive systematic review of its kind, reaffirms this with an even larger, global patient base.

“We urgently need to take stock of the evidence for common musculoskeletal conditions, a largely under-recognised health priority, and make sure people are receiving appropriate care.”

The Medicines and Healthcare products Regulatory Agency is currently carrying out a wide-ranging review into the dangers of paracetamol. Nice has said will continue to recommend the painkiller until that review is complete.

The drugs regulator said it could not comment on the new research because it was too close to the general election.